الفهرس 
HISTORY OF ATTENTION DEFICIT HYPERACTIVITY DISORDEROnly 14 pages are availabe for public view
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Abstract
ADHD is one of the most common neurodevelopmental disorders. Despite the presence of evidence based approved diagnosing and treatment tools for ADHD, there still is an underdiagnoses and underutilization of these services. Untreated ADHD, unlike what some families may believe, doesn’t go away on its own, in fact, the condition may get worse with age, affecting more domains of the child’s life as an adolescent and later on as an adult. In addition, untreated ADHD impacts not only the patient, but also the family and the society as a whole.
In this study we aimed to investigate different routes that parents take before reaching the child and adolescence psychiatric services. And to further discover reasons for any delay in seeking psychiatric help. In addition we aimed to estimate the duration of untreated ADHD before receiving proper psychiatric treatment.
An initial pilot study was conducted over 2 months from January 2019 till March 2019, followed by the main study which was conducted a period of 4 months from March 2019 till July 2019.
A total of 350 cases were recruited in our cross sectional study that took place at the child and adolescence outpatient clinic at Abbassia mental health hospital in Cairo, Egypt. Our inclusion criteria included:
1. Children of both genders male and female.
2. Children and less than 18 years.
3. Cases with no history of major sensory or motor disability as blindness, deafness or paralysis.
On the other hand, our exclusion criteria included:
1. Cases older than 18 years old.
2. Children who had history of sensory or motor disability.
3. Families who were unable to give written consents.
40 patients were excluded from the study, 4 of which were excluded because there was no reliable informant present, 18 families were not able to give a written consent, 12 families were not able to complete the whole interview, and finally 6 cases didn’t fulfill the full criteria for the ADHD diagnosis according to the DSM V.
The tools used in the study are the following:
1. A researcher designed questionnaire including questions about personal and sociodemographic data, different consultations and referral places sought before reaching psychiatric help at CAMHS, most distressing symptom, reasons that contributed to any delay before reaching proper service.
2. The Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-PL): a semi structured clinical interview scale, Present and Life time version. The K-SADS-PL was used to diagnose or to confirm diagnosis of the recruited cases along with identifying any comorbidity present. (Kaufman et al., 1996).
3. Conner’s parents rating scale was used for the parents to assess severity of symptoms. (Albeheiry et al., 2010)
4. Fahmy and El Sheribini social scale that was used to assess the Socioeconomic class of the studied sample. (Fahmi and El-sherbini, 1986)
Results showed that the average delay in seeking psychiatric service and the duration of untreated ADHD was 3±2 years. The majority of parents, 27.1%, 1st consulted pediatricians as regards to their child’s symptoms.
The most commonly reported source of referral was school teachers in 23.1%.
The most frequently mentioned reason for taking an action, or in other words the most distressing symptom that caused the parents to reach for help at a psychiatric setting, was impulsivity (28.1%). Parents complained that the child was constantly hurting himself and getting into fights with peers, and teachers complained frequently from the child’s behavior and suggested that there is a problem that needs to be addressed.
The most reported reason for delay was fear of stigma of mental illness, this reason was mentioned by 23.5% of the sample. Parents were reluctant because they were afraid the child would be stigmatized with mental illness which could affect his life negatively.
The above findings points towards the importance of raising awareness and correcting false stigmatizing belief about child mental health and illness. This can lessen the stigma and spread awareness which can consequently shorten any delay and enhancing the child’s quality of life later on through receiving proper diagnosis and treatment as early as possible.
School teachers (e.g. elementary school teachers) and health care professionals especially pediatricians should be targeted by child mental health training programs to help detect early ADHD symptoms thus sparing families time and referring to CAMHS directly thus helping the child, the families, and making good use of the available psychiatric services by using them properly.